Recurrence of Clostridium difficile infection among veterans with spinal cord injury and disorder
Background Recurrent Clostridium difficile (CDI) infection is a growing concern; however, there are little data on impact of recurrent CDI on those with spinal cord injury and disorder (SCI/D). Therefore, the objective of this study was to identify risk factors associated with recurrence of CDI amon...
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| Veröffentlicht in: | American journal of infection control 2014-02, Vol.42 (2), p.168-173 |
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| creator | Ramanathan, Swetha, MPH Johnson, Stuart, MD Burns, Stephen P., MD Kralovic, Stephen M., MD, MPH Goldstein, Barry, MD, PhD Smith, Bridget, PhD, MPA Gerding, Dale N., MD Evans, Charlesnika T., PhD, MPH |
| description | Background Recurrent Clostridium difficile (CDI) infection is a growing concern; however, there are little data on impact of recurrent CDI on those with spinal cord injury and disorder (SCI/D). Therefore, the objective of this study was to identify risk factors associated with recurrence of CDI among Veterans with SCI/D. Methods This was a retrospective cohort study with data from outpatient, inpatient, and extended care settings at 83 Department of Veterans Affairs facilities from 2002 to 2009. Results Of 1,464 cases of CDI analyzed, 315 cases (21.5%) had a first recurrence of CDI. Multivariable regression demonstrated that risk factors significantly associated with increased recurrence were concomitant fluoroquinolone use (odds ratio [OR], 1.39; 95% confidence interval [CI]: 1.08-1.80), whereas concomitant tetracycline use (OR, 0.35; 95% CI: 0.14-0.90), and cerebrovascular accident (OR, 0.46; 95% CI: 0.25-0.85) were associated with decreased recurrence. A subanalysis in those with health care facility-onset CDI showed that increased length of stay postinitial CDI was a significant risk factor for recurrence as was concomitant use of fluoroquinolones and that tetracycline remained protective for recurrence. Conclusion Concomitant fluoroquinolone use was a risk factor for the recurrence of CDI. In contrast, tetracyclines and cerebrovascular accident were protective. Length of stay greater than 90 days from the initial CDI episode was also a risk factor for recurrence among those with health care facility-onset CDI. Future studies should focus on effective strategies to prevent these risk factors among the SCI/D population. |
| doi_str_mv | 10.1016/j.ajic.2013.08.009 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1494314956</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0196655313012091</els_id><sourcerecordid>3223843111</sourcerecordid><originalsourceid>FETCH-LOGICAL-c469t-6274cbdc1682adb82fda2ee7c6edfb2a3b8bc296643a70bb4dc3a97f2888a2993</originalsourceid><addsrcrecordid>eNp9kltr3DAQhUVpaTbb_oE-FEEJ5MWuLrYsQwmEpTcIBHp5FrI0auXa1layU_bfV2a3DeQhLxKIb0ZzzhmEXlFSUkLF277UvTclI5SXRJaEtE_QhtasKThrxVO0IbQVhahrfobOU-pJJrion6MzVlWy5g3bIP0FzBIjTAZwcHg3hDRHb_0yYuud88YPgP3kwMw-TFiPYfqB72CGqKeE__j5J057P-kBmxBtJvslHrCebC5P-QXiC_TM6SHBy9O9Rd8_vP-2-1Tc3H78vLu-KUwl2rkQrKlMZw0VkmnbSeasZgCNEWBdxzTvZGeyLFFx3ZCuq6zhum0ck1Jq1rZ8iy6Pffcx_F4gzWr0ycAw6AnCkhSt2ornoxYZffMA7cMSs4hM1YRwUmfnMsWOlIkhpQhO7aMfdTwoStQagOrVGoBaA1BEqtXeLXp9ar10I9j_Jf8cz8DFCdDJ6MFlH41P95xkNeGsyty7IwfZszsPUSXj15isjzkMZYN_fI6rB-Vm8JPPP_6CA6R7vSoxRdTXdVXWTaGcUEZayv8C4GW5gQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1500305019</pqid></control><display><type>article</type><title>Recurrence of Clostridium difficile infection among veterans with spinal cord injury and disorder</title><source>Elsevier ScienceDirect Journals Complete - AutoHoldings</source><source>MEDLINE</source><creator>Ramanathan, Swetha, MPH ; Johnson, Stuart, MD ; Burns, Stephen P., MD ; Kralovic, Stephen M., MD, MPH ; Goldstein, Barry, MD, PhD ; Smith, Bridget, PhD, MPA ; Gerding, Dale N., MD ; Evans, Charlesnika T., PhD, MPH</creator><creatorcontrib>Ramanathan, Swetha, MPH ; Johnson, Stuart, MD ; Burns, Stephen P., MD ; Kralovic, Stephen M., MD, MPH ; Goldstein, Barry, MD, PhD ; Smith, Bridget, PhD, MPA ; Gerding, Dale N., MD ; Evans, Charlesnika T., PhD, MPH</creatorcontrib><description>Background Recurrent Clostridium difficile (CDI) infection is a growing concern; however, there are little data on impact of recurrent CDI on those with spinal cord injury and disorder (SCI/D). Therefore, the objective of this study was to identify risk factors associated with recurrence of CDI among Veterans with SCI/D. Methods This was a retrospective cohort study with data from outpatient, inpatient, and extended care settings at 83 Department of Veterans Affairs facilities from 2002 to 2009. Results Of 1,464 cases of CDI analyzed, 315 cases (21.5%) had a first recurrence of CDI. Multivariable regression demonstrated that risk factors significantly associated with increased recurrence were concomitant fluoroquinolone use (odds ratio [OR], 1.39; 95% confidence interval [CI]: 1.08-1.80), whereas concomitant tetracycline use (OR, 0.35; 95% CI: 0.14-0.90), and cerebrovascular accident (OR, 0.46; 95% CI: 0.25-0.85) were associated with decreased recurrence. A subanalysis in those with health care facility-onset CDI showed that increased length of stay postinitial CDI was a significant risk factor for recurrence as was concomitant use of fluoroquinolones and that tetracycline remained protective for recurrence. Conclusion Concomitant fluoroquinolone use was a risk factor for the recurrence of CDI. In contrast, tetracyclines and cerebrovascular accident were protective. Length of stay greater than 90 days from the initial CDI episode was also a risk factor for recurrence among those with health care facility-onset CDI. Future studies should focus on effective strategies to prevent these risk factors among the SCI/D population.</description><identifier>ISSN: 0196-6553</identifier><identifier>EISSN: 1527-3296</identifier><identifier>DOI: 10.1016/j.ajic.2013.08.009</identifier><identifier>PMID: 24485372</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents - therapeutic use ; Bacterial diseases ; Bacterial diseases of the digestive system and abdomen ; Bacterial infections ; Biological and medical sciences ; C difficile infection ; Clostridium difficile - isolation & purification ; Clostridium Infections - chemically induced ; Clostridium Infections - epidemiology ; Clostridium Infections - microbiology ; Cohort Studies ; Concomitant antibiotics ; Diarrhea - chemically induced ; Diarrhea - epidemiology ; Diarrhea - microbiology ; Epidemiology. Vaccinations ; Female ; First recurrence ; Fluoroquinolones - therapeutic use ; Gastroenterology. Liver. Pancreas. Abdomen ; General aspects ; Human bacterial diseases ; Humans ; Infection Control ; Infectious Disease ; Infectious diseases ; Length of Stay ; Male ; Medical sciences ; Middle Aged ; Other diseases. Semiology ; Recurrence ; Regression analysis ; Retrospective Studies ; Risk Factors ; Spinal Cord Diseases - complications ; Spinal cord injuries ; Spinal Cord Injuries - complications ; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus ; Veterans ; Veterans Affairs ; Young Adult</subject><ispartof>American journal of infection control, 2014-02, Vol.42 (2), p.168-173</ispartof><rights>2014</rights><rights>2015 INIST-CNRS</rights><rights>Published by Mosby, Inc.</rights><rights>Copyright Mosby-Year Book, Inc. Feb 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c469t-6274cbdc1682adb82fda2ee7c6edfb2a3b8bc296643a70bb4dc3a97f2888a2993</citedby><cites>FETCH-LOGICAL-c469t-6274cbdc1682adb82fda2ee7c6edfb2a3b8bc296643a70bb4dc3a97f2888a2993</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ajic.2013.08.009$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3549,27923,27924,45994</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28250324$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24485372$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ramanathan, Swetha, MPH</creatorcontrib><creatorcontrib>Johnson, Stuart, MD</creatorcontrib><creatorcontrib>Burns, Stephen P., MD</creatorcontrib><creatorcontrib>Kralovic, Stephen M., MD, MPH</creatorcontrib><creatorcontrib>Goldstein, Barry, MD, PhD</creatorcontrib><creatorcontrib>Smith, Bridget, PhD, MPA</creatorcontrib><creatorcontrib>Gerding, Dale N., MD</creatorcontrib><creatorcontrib>Evans, Charlesnika T., PhD, MPH</creatorcontrib><title>Recurrence of Clostridium difficile infection among veterans with spinal cord injury and disorder</title><title>American journal of infection control</title><addtitle>Am J Infect Control</addtitle><description>Background Recurrent Clostridium difficile (CDI) infection is a growing concern; however, there are little data on impact of recurrent CDI on those with spinal cord injury and disorder (SCI/D). Therefore, the objective of this study was to identify risk factors associated with recurrence of CDI among Veterans with SCI/D. Methods This was a retrospective cohort study with data from outpatient, inpatient, and extended care settings at 83 Department of Veterans Affairs facilities from 2002 to 2009. Results Of 1,464 cases of CDI analyzed, 315 cases (21.5%) had a first recurrence of CDI. Multivariable regression demonstrated that risk factors significantly associated with increased recurrence were concomitant fluoroquinolone use (odds ratio [OR], 1.39; 95% confidence interval [CI]: 1.08-1.80), whereas concomitant tetracycline use (OR, 0.35; 95% CI: 0.14-0.90), and cerebrovascular accident (OR, 0.46; 95% CI: 0.25-0.85) were associated with decreased recurrence. A subanalysis in those with health care facility-onset CDI showed that increased length of stay postinitial CDI was a significant risk factor for recurrence as was concomitant use of fluoroquinolones and that tetracycline remained protective for recurrence. Conclusion Concomitant fluoroquinolone use was a risk factor for the recurrence of CDI. In contrast, tetracyclines and cerebrovascular accident were protective. Length of stay greater than 90 days from the initial CDI episode was also a risk factor for recurrence among those with health care facility-onset CDI. Future studies should focus on effective strategies to prevent these risk factors among the SCI/D population.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Bacterial diseases</subject><subject>Bacterial diseases of the digestive system and abdomen</subject><subject>Bacterial infections</subject><subject>Biological and medical sciences</subject><subject>C difficile infection</subject><subject>Clostridium difficile - isolation & purification</subject><subject>Clostridium Infections - chemically induced</subject><subject>Clostridium Infections - epidemiology</subject><subject>Clostridium Infections - microbiology</subject><subject>Cohort Studies</subject><subject>Concomitant antibiotics</subject><subject>Diarrhea - chemically induced</subject><subject>Diarrhea - epidemiology</subject><subject>Diarrhea - microbiology</subject><subject>Epidemiology. Vaccinations</subject><subject>Female</subject><subject>First recurrence</subject><subject>Fluoroquinolones - therapeutic use</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>General aspects</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Infection Control</subject><subject>Infectious Disease</subject><subject>Infectious diseases</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Other diseases. Semiology</subject><subject>Recurrence</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Spinal Cord Diseases - complications</subject><subject>Spinal cord injuries</subject><subject>Spinal Cord Injuries - complications</subject><subject>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</subject><subject>Veterans</subject><subject>Veterans Affairs</subject><subject>Young Adult</subject><issn>0196-6553</issn><issn>1527-3296</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kltr3DAQhUVpaTbb_oE-FEEJ5MWuLrYsQwmEpTcIBHp5FrI0auXa1layU_bfV2a3DeQhLxKIb0ZzzhmEXlFSUkLF277UvTclI5SXRJaEtE_QhtasKThrxVO0IbQVhahrfobOU-pJJrion6MzVlWy5g3bIP0FzBIjTAZwcHg3hDRHb_0yYuud88YPgP3kwMw-TFiPYfqB72CGqKeE__j5J057P-kBmxBtJvslHrCebC5P-QXiC_TM6SHBy9O9Rd8_vP-2-1Tc3H78vLu-KUwl2rkQrKlMZw0VkmnbSeasZgCNEWBdxzTvZGeyLFFx3ZCuq6zhum0ck1Jq1rZ8iy6Pffcx_F4gzWr0ycAw6AnCkhSt2ornoxYZffMA7cMSs4hM1YRwUmfnMsWOlIkhpQhO7aMfdTwoStQagOrVGoBaA1BEqtXeLXp9ar10I9j_Jf8cz8DFCdDJ6MFlH41P95xkNeGsyty7IwfZszsPUSXj15isjzkMZYN_fI6rB-Vm8JPPP_6CA6R7vSoxRdTXdVXWTaGcUEZayv8C4GW5gQ</recordid><startdate>20140201</startdate><enddate>20140201</enddate><creator>Ramanathan, Swetha, MPH</creator><creator>Johnson, Stuart, MD</creator><creator>Burns, Stephen P., MD</creator><creator>Kralovic, Stephen M., MD, MPH</creator><creator>Goldstein, Barry, MD, PhD</creator><creator>Smith, Bridget, PhD, MPA</creator><creator>Gerding, Dale N., MD</creator><creator>Evans, Charlesnika T., PhD, MPH</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Mosby-Year Book, Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140201</creationdate><title>Recurrence of Clostridium difficile infection among veterans with spinal cord injury and disorder</title><author>Ramanathan, Swetha, MPH ; Johnson, Stuart, MD ; Burns, Stephen P., MD ; Kralovic, Stephen M., MD, MPH ; Goldstein, Barry, MD, PhD ; Smith, Bridget, PhD, MPA ; Gerding, Dale N., MD ; Evans, Charlesnika T., PhD, MPH</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c469t-6274cbdc1682adb82fda2ee7c6edfb2a3b8bc296643a70bb4dc3a97f2888a2993</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Bacterial diseases</topic><topic>Bacterial diseases of the digestive system and abdomen</topic><topic>Bacterial infections</topic><topic>Biological and medical sciences</topic><topic>C difficile infection</topic><topic>Clostridium difficile - isolation & purification</topic><topic>Clostridium Infections - chemically induced</topic><topic>Clostridium Infections - epidemiology</topic><topic>Clostridium Infections - microbiology</topic><topic>Cohort Studies</topic><topic>Concomitant antibiotics</topic><topic>Diarrhea - chemically induced</topic><topic>Diarrhea - epidemiology</topic><topic>Diarrhea - microbiology</topic><topic>Epidemiology. Vaccinations</topic><topic>Female</topic><topic>First recurrence</topic><topic>Fluoroquinolones - therapeutic use</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>General aspects</topic><topic>Human bacterial diseases</topic><topic>Humans</topic><topic>Infection Control</topic><topic>Infectious Disease</topic><topic>Infectious diseases</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Other diseases. Semiology</topic><topic>Recurrence</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Spinal Cord Diseases - complications</topic><topic>Spinal cord injuries</topic><topic>Spinal Cord Injuries - complications</topic><topic>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</topic><topic>Veterans</topic><topic>Veterans Affairs</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ramanathan, Swetha, MPH</creatorcontrib><creatorcontrib>Johnson, Stuart, MD</creatorcontrib><creatorcontrib>Burns, Stephen P., MD</creatorcontrib><creatorcontrib>Kralovic, Stephen M., MD, MPH</creatorcontrib><creatorcontrib>Goldstein, Barry, MD, PhD</creatorcontrib><creatorcontrib>Smith, Bridget, PhD, MPA</creatorcontrib><creatorcontrib>Gerding, Dale N., MD</creatorcontrib><creatorcontrib>Evans, Charlesnika T., PhD, MPH</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of infection control</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ramanathan, Swetha, MPH</au><au>Johnson, Stuart, MD</au><au>Burns, Stephen P., MD</au><au>Kralovic, Stephen M., MD, MPH</au><au>Goldstein, Barry, MD, PhD</au><au>Smith, Bridget, PhD, MPA</au><au>Gerding, Dale N., MD</au><au>Evans, Charlesnika T., PhD, MPH</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Recurrence of Clostridium difficile infection among veterans with spinal cord injury and disorder</atitle><jtitle>American journal of infection control</jtitle><addtitle>Am J Infect Control</addtitle><date>2014-02-01</date><risdate>2014</risdate><volume>42</volume><issue>2</issue><spage>168</spage><epage>173</epage><pages>168-173</pages><issn>0196-6553</issn><eissn>1527-3296</eissn><abstract>Background Recurrent Clostridium difficile (CDI) infection is a growing concern; however, there are little data on impact of recurrent CDI on those with spinal cord injury and disorder (SCI/D). Therefore, the objective of this study was to identify risk factors associated with recurrence of CDI among Veterans with SCI/D. Methods This was a retrospective cohort study with data from outpatient, inpatient, and extended care settings at 83 Department of Veterans Affairs facilities from 2002 to 2009. Results Of 1,464 cases of CDI analyzed, 315 cases (21.5%) had a first recurrence of CDI. Multivariable regression demonstrated that risk factors significantly associated with increased recurrence were concomitant fluoroquinolone use (odds ratio [OR], 1.39; 95% confidence interval [CI]: 1.08-1.80), whereas concomitant tetracycline use (OR, 0.35; 95% CI: 0.14-0.90), and cerebrovascular accident (OR, 0.46; 95% CI: 0.25-0.85) were associated with decreased recurrence. A subanalysis in those with health care facility-onset CDI showed that increased length of stay postinitial CDI was a significant risk factor for recurrence as was concomitant use of fluoroquinolones and that tetracycline remained protective for recurrence. Conclusion Concomitant fluoroquinolone use was a risk factor for the recurrence of CDI. In contrast, tetracyclines and cerebrovascular accident were protective. Length of stay greater than 90 days from the initial CDI episode was also a risk factor for recurrence among those with health care facility-onset CDI. Future studies should focus on effective strategies to prevent these risk factors among the SCI/D population.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>24485372</pmid><doi>10.1016/j.ajic.2013.08.009</doi><tpages>6</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Anti-Bacterial Agents - therapeutic use Bacterial diseases Bacterial diseases of the digestive system and abdomen Bacterial infections Biological and medical sciences C difficile infection Clostridium difficile - isolation & purification Clostridium Infections - chemically induced Clostridium Infections - epidemiology Clostridium Infections - microbiology Cohort Studies Concomitant antibiotics Diarrhea - chemically induced Diarrhea - epidemiology Diarrhea - microbiology Epidemiology. Vaccinations Female First recurrence Fluoroquinolones - therapeutic use Gastroenterology. Liver. Pancreas. Abdomen General aspects Human bacterial diseases Humans Infection Control Infectious Disease Infectious diseases Length of Stay Male Medical sciences Middle Aged Other diseases. Semiology Recurrence Regression analysis Retrospective Studies Risk Factors Spinal Cord Diseases - complications Spinal cord injuries Spinal Cord Injuries - complications Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Veterans Veterans Affairs Young Adult |
| title | Recurrence of Clostridium difficile infection among veterans with spinal cord injury and disorder |
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